Prosthetic valve with flow director

ABSTRACT

A prosthetic valve comprising a stent frame, a valve structure, and a baffle structure. The stent frame defines a lumen. The valve structure is disposed within the lumen, and defines an inflow side and an outflow side. An outflow track is established within the lumen downstream of the outflow side and along which fluid flow from the valve structure progresses. The baffle structure is connected to the stent frame downstream of the outflow side. In some embodiments, the baffle structure directs blood flow into designated areas to encourage laminar flow and eliminate or reduce turbulence.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.14/301,632, filed Jun. 11, 2014, and entitled “Prosthetic Valve WithVortices-Including Baffle”; the entire teachings of which areincorporated herein by reference.

BACKGROUND

The present disclosure relates to prosthetic valves. More particularly,it relates structures, devices and methods for manipulating fluid flowat a prosthetic valve, such as a prosthetic heart valve.

A human heart includes four heart valves that determine the pathway ofblood flow through the heart: the mitral valve, the tricuspid valve, theaortic valve, and the pulmonary valve. The mitral and tricuspid valvesare atrio-ventricular valves, which are between the atria and theventricles, while the aortic and pulmonary valves are semilunar valves,which are in the arteries leaving the heart. The tricuspid valve, alsoknown as the right atrio-ventricular valve, is a tri-flap valve locatedbetween the right atrium and the right ventricle. The mitral valve, alsoknown as the bicuspid or left atrio-ventricular valve, is a dual-flapvalve located between the left atrium and the left ventricle.

As with other valves of the heart, the mitral valve is a passivestructure in that it does not itself expend any energy and does notperform any active contractile function. The mitral valve includes anannulus that provides attachment for the two leaflets (anterior leafletand posterior leaflet) that each open and close in response todifferential pressures on either side of the valve. The leaflets of themitral valve are dissimilarly shaped. The anterior leaflet is morefirmly attached to the annulus, and is somewhat stiffer than theposterior leaflet (that is otherwise attached to the more mobileposterior lateral mitral annulus). The anterior leaflet protectsapproximately two-thirds of the valve. The anterior leaflet takes up alarger part of the annulus and is generally considered to be “larger”than the posterior leaflet (although the posterior leaflet has a largersurface area). In a healthy mitral valve, then, the anterior andposterior leaflets are asymmetric.

Ideally, the leaflets of a heart valve move apart from each other whenthe valve is in an open position, and meet or “coapt” when the valve isin a closed position. Problems that may develop with valves includestenosis in which a valve does not open properly, and/or insufficiencyor regurgitation in which a valve does not close properly. Stenosis andinsufficiency may occur concomitantly in the same valve. The effects ofvalvular dysfunction vary, with regurgitation or backflow typicallyhaving relatively severe physiological consequences to the patient.

Diseased or otherwise deficient heart valves can be repaired or replacedusing a variety of different types of heart valve surgeries. Oneconventional technique involves an open-heart surgical approach that isconducted under general anesthesia, during which the heart is stoppedand blood flow is controlled by a heart-lung bypass machine.

More recently, minimally invasive approaches have been developed tofacilitate catheter-based implantation of the valve prosthesis on thebeating heart, intending to obviate the need for the use of classicalsternotomy and cardiopulmonary bypass. In general terms, an expandableprosthetic valve is compressed about or within a catheter, insertedinside a body lumen of the patient, such as the femoral artery, anddelivered to a desired location in the heart.

The heart valve prosthesis employed with catheter-based, ortranscatheter, procedures generally includes an expandable multi-levelframe or stent that supports a valve structure having a plurality ofleaflets. The frame can be contracted during percutaneous transluminaldelivery, and expanded upon deployment at or within the native valve.One type of valve stent can be initially provided in an expanded oruncrimped condition, then crimped or compressed about a balloon portionof a catheter. The balloon is subsequently inflated to expand and deploythe prosthetic heart valve. With other stented prosthetic heart valvedesigns, the stent frame is formed to be self-expanding. With thesesystems, the valved stent is crimped down to a desired size and held inthat compressed state within a sheath for transluminal delivery.Retracting the sheath from this valved stent allows the stent toself-expand to a larger diameter, fixating at the native valve site. Inmore general terms, then, once the prosthetic valve is positioned at thetreatment site, for instance within an incompetent native valve, thestent frame structure may be expanded to hold the prosthetic valvefirmly in place. One example of a stented prosthetic valve is disclosedin U.S. Pat. No. 5,957,949 to Leonhardt et al., which is incorporated byreference herein in its entirety.

The actual shape and configuration of any particular transcatheterprosthetic heart valve is dependent, at least to some extent, upon thevalve being replaced or repaired (i.e., mitral valve, tricuspid valve,aortic valve, or pulmonary valve). The stent frame must oftentimesprovide and maintain (e.g., elevated hoop strength and resistance toradially compressive forces) a relatively complex shape in order toachieve desired fixation with the corresponding native anatomy.Moreover, the stent frame must have a robust design capable oftraversing the tortuous path leading to the native valve annulus site.These constraints, as well other delivery obstacles such as difficultiesin precisely locating and rotationally orienting the prosthetic valverelative to the native annulus, dictate that in some instances, it isbeneficial to utilize a valve structure with the prosthesis thatpurposefully differs from the native (healthy) valve structure orleaflets. For example, the transcatheter prosthetic heart valve mayincorporate a symmetric valve structure for replacing an asymmetricnative valve, an asymmetric valve structure to replace a symmetricnative valve, a valve structure having a greater or lesser number ofleaflets than the native valve, a valve structure having leaflet shapesdiffering from the native valve, etc. These same design choices canarise in the context of other intraluminal prosthetic valves.

While the so-configured prosthetic valve can thus achieve the intendedbenefits (such as ease of implant) along with long term viableperformance as a functioning valve, in some instances other concerns mayarise. For example, in many cases, the normally healthy native valvefunctions to not only open and close, but also effectuates a certainvelocity profile in the blood flow exiting the valve. For example, in ahealthy mitral valve, the asymmetric, bi-cuspid nature (and thecoaptation mechanism of the larger anterior leaflet) results in vorticesbeing formed in the left ventricle during filling. These vortices helpsynchronize the heart beat and aid in efficient ventricular ejection. Aprosthetic mitral valve that does not directly mimic these attributes ofthe native mitral valve may not generate the normal vortical flowpattern, possibly leading to complications. The failure of a prostheticvalve to account for the natural hemodynamics of the blood through andfrom other valves of the human body can give rise to similar concerns.

Other concerns relate to possible stasis and thrombus formation at theprosthetic valve resulting from localized regions of turbulent orstagnant flow.

Although there have been multiple advances in transcatheter prostheticheart valves (and other intraluminal valves) and related deliverysystems and techniques, there is a continuing need to provide a valvedprosthesis with improved flow profiles.

SUMMARY

Some aspects of the present disclosure relate to a prosthetic valvehaving an inflow end opposite an outflow end, and comprising a stentframe, a valve structure, and a baffle structure. The stent framedefines a lumen. The valve structure is disposed within the lumen and isconfigured to define an inflow side and an outflow side. An outflowtrack is established within the lumen downstream of the outflow side andalong which fluid (e.g., blood) flow from the valve structure willprogress following implant. The baffle structure is connected to thestent frame proximate and downstream of the valve structure outflowside. With this construction, the baffle structure will modify ormanipulate a natural profile of blood flow exiting the valve structureto eliminate or reduce turbulent and/or stagnant regions as the bloodflow subsequently interfaces with the stent structure or other regionsof the prosthetic valve. By reducing or eliminating turbulence and/orstagnant flow, a likelihood of thrombus formation is reduced. In someembodiments, the baffle structure is configured and located to encouragelaminar or near-laminar flow.

Other aspects of the present disclosure are directed toward a method ofregulating fluid (e.g., blood flow) flow through a body vessel of apatient. The method includes implanting a prosthetic valve within thebody vessel. The prosthetic valve has an inflow end opposite an outflowend, and includes a stent frame, a valve structure, and a bafflestructure. The stent frame defines a lumen. The valve structure isdisposed within the lumen and is configured to define an inflow side andan outflow side. An outflow track is established within the lumendownstream of the outflow side and along which fluid flow from the valvestructure can progress. The baffle structure is connected to the stentframe downstream of the outflow side, and in some embodiments isconfigured and located to encourage laminar or near-laminar flow.Following the step of implanting the prosthetic valve, fluid flow withinthe body vessel is naturally directed to the inflow side. The valvestructure functions to alternately allow and occlude fluid flow betweenthe inflow and outflow sides. Further, the baffle structure functions toreduce or eliminate occurrences of stagnant or turbulent flow as thefluid flow subsequently interfaces with the stent frame or other regionsof the prosthetic valve.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a schematic side view of a prosthetic valve in accordancewith principles of the present disclosure and in a normal, expandedcondition;

FIG. 1B is a schematic side view of the prosthetic valve of FIG. 1A andin a compressed condition;

FIG. 1C is a schematic side view of another prosthetic valve inaccordance with principles of the present disclosure;

FIG. 2 is a schematic cross-sectional view of the prosthetic valve ofFIG. 1A located within a body vessel;

FIG. 3 is a schematic cross-sectional view of a prior art prostheticvalve located within the body vessel of FIG. 2;

FIG. 4 is a side view of a prosthetic mitral valve in accordance withprinciples of the present disclosure and useful as a prosthetic mitralvalve;

FIG. 5 is a simplified cross-sectional view of a portion of a humanheart;

FIG. 6 illustrates the prosthetic valve of FIG. 4 implanted at a mitralvalve target location of the heart of FIG. 5;

FIG. 7 illustrates a blood flow profile generated by a prior artprosthetic mitral valve implanted at a mitral valve target location ofthe heart of FIG. 5;

FIG. 8 is a side view of another prosthetic valve in accordance withprinciples of the present disclosure;

FIG. 9 is a side view of another prosthetic valve in accordance withprinciples of the present disclosure;

FIG. 10 is a side view of another prosthetic valve in accordance withprinciples of the present disclosure;

FIG. 11A is a side view of another prosthetic valve in accordance withprinciples of the present disclosure; and

FIG. 11B is a top plan view of the prosthetic valve of FIG. 11A.

DETAILED DESCRIPTION

Specific embodiments of the present disclosure are now described withreference to the figures, wherein like reference numbers indicateidentical or functionally similar elements. The terms “distal” and“proximal” are used in the following description with respect to aposition or direction relative to the treating clinician. “Distal” or“distally” are a position distant from or in a direction away from theclinician. “Proximal” and “proximally” are a position near or in adirection toward the clinician. As used herein with reference to animplanted valve prosthesis, the terms “distal”, “outlet”, and “outflow”are understood to mean downstream to the direction of blood flow, andthe terms “proximal”, “inlet”, or “inflow” are understood to meanupstream to the direction of blood flow. In addition, as used herein,the terms “outward” or “outwardly” refer to a position radially awayfrom a longitudinal axis of a frame of the valve prosthesis and theterms “inward” or “inwardly” refer to a position radially toward alongitudinal axis of the frame of the valve prosthesis. As well theterms “backward” or “backwardly” refer to the relative transition from adownstream position to an upstream position and the terms “forward” or“forwardly” refer to the relative transition from an upstream positionto a downstream position.

The following detailed description of prosthetic valves of the presentdisclosure is merely exemplary in nature and is not intended to limitthe disclosure or the application and uses of the prosthetic valves ofthe present disclosure. Although the description is in the context oftreatment of heart valves such as the mitral valve, the prostheticvalves of the present disclosure also may be used in any other bodypassageways, organs, etc., where it is deemed useful. Furthermore, thereis no intention to be bound by any expressed or implied theory presentedin the present disclosure.

As referred to herein, stented prosthetic valves, such as stentedtranscatheter prosthetic heart valves, of the present disclosure mayassume a wide variety of different configurations, such as abioprosthetic heart valve having tissue leaflets or a synthetic heartvalve having polymeric, metallic or tissue-engineered leaflets, and canbe specifically configured for replacing any of the four valves of thehuman heart. Thus, the stented prosthetic heart valves of the presentdisclosure can be generally used for replacement of a native mitral,aortic, pulmonic or tricuspid valve, or to replace a failedbioprosthesis, such as in the area of a mitral valve or an aortic valve,for example.

In general terms, the stented prosthetic valves (or more simply,“prosthetic valves”) of the present disclosure include a stent or stentframe having an internal lumen maintaining a valve structure (tissue orsynthetic), with the stent frame having a normal, expanded condition orarrangement and collapsible to a compressed condition or arrangement forloading within a delivery device. The stent frame is normallyconstructed to self-deploy or self-expand when released from thedelivery device. For example, the stents or stent frames are supportstructures that comprise a number of struts or wire segments arrangedrelative to each other to provide a desired compressibility and strengthto the prosthetic heart valve. The struts or wire segments are arrangedsuch that they are capable of self-transitioning from a compressed orcollapsed condition to a normal, radially expanded condition. The strutsor wire segments can be formed from a shape memory material, such as anickel titanium alloy (e.g., Nitinol™). The stent frame can be laser-cutfrom a single piece of material, or can be assembled from a number ofdiscrete components.

With the above understanding in mind, one non-limiting example of astented prosthetic valve 30 in accordance with principles of the presentdisclosure is schematically illustrated in FIG. 1A. As a point ofreference, the prosthetic valve 30 is represented in a normal orexpanded condition in the view of FIG. 1A; FIG. 1B represents theprosthetic valve 30 in a compressed condition (e.g., when compressivelyretained within an outer catheter or sheath). The prosthetic valve 30has or defines an inflow end 32 opposite an outflow end 34, and includesa stent or stent frame 36, a valve structure 38, and one or more bafflestructures, such as a vortical flow baffle structure 40 (referencedgenerally). Alternatively or in addition, and as schematically shown forthe alternative prosthetic valve 30′ of FIG. 1C, the baffle structure ofthe present disclosure can be a laminar flow baffle structure 41.Details on the various components are provided below. In general terms,the stent frame 36 defines a lumen 42, an inflow margin 44 and anoutflow margin 46 opposite the inflow margin 44. In the exemplaryembodiments of FIGS. 1A-1C, the inflow margin 44 of the stent frame 36serves as or defines the inflow end 32 of the prosthetic valve 30, andthe outflow margin 46 serves as or defines the outflow end 34. In otherembodiments, one or more bodies of the prosthetic valve 30 projectbeyond (in the downstream direction) the outflow margin 46 of the stentframe 36 to define or serve as the outflow end 34 of the prostheticvalve 30, and/or upstream of the inflow margin 44 to define the inflowend 32.

The valve structure 38 is disposed within the lumen 42, and isconfigured to define an inflow side 50 and an outflow side 52 oppositethe inflow side 50. An outflow track 60 is established within the lumen42 downstream of the outflow side 52 and along which fluid flow (e.g.,blood flow) from the valve structure 38 progresses during use (in beingunderstood that in the view of FIG. 1A, the valve structure 38 is in aclosed state or position). The vortical flow baffle structure 40 isconnected to the stent frame 36 and in some embodiments projects intothe outflow track 60. As described in greater detail below, the vorticalflow baffle structure 40 is configured and located to manipulate fluidflow from the valve structure 38, for example affecting a velocityprofile of the fluid flow to be or include vortical flow. In otherembodiments described below, the laminar flow baffle structure 41 isprovided, configured and located to manipulate fluid flow immediately atthe outflow side 52, for example modifying the blood flow in and aroundthe prosthetic valve 30 to reduce or eliminate turbulent (or stagnant)regions that might otherwise lead to thrombus. In yet other embodiments,the prosthetic valves of the present disclosure include both thevortical flow baffle structure 40 (for inducing vortical flow) and thelaminar flow baffle structure 41 (for reducing or eliminating turbulentflow at target areas).

The stent frame 36 can assume any of the forms mentioned above, and isgenerally constructed so as to be expandable from the compressedcondition (FIG. 1B) to the normal, expanded condition (FIG. 1A). Thestent frame 36 can have a lattice or cell-like structure. The stentframe 36 can be made from stainless steel, a pseudo-elastic metal suchas a nickel titanium alloy or Nitinol™, or a so-called super alloy,which may have a base metal of nickel, cobalt, chromium, or other metal.In some embodiments, the stent frame 36 is self-expanding to return tothe normal expanded condition from the compressed condition.“Self-expanding” as used herein means that the stent frame 36 has amechanical memory to return to the normal or expanded condition.Mechanical memory can be imparted to the wire or tubular structure thatforms the stent frame 36 by thermal treatment to achieve a spring temperin stainless steel, for example, or to set a shape memory in asusceptible metal allow, such as Nitinol, or a polymer, such as any ofthe polymers disclosed in US Application Publication No. 2004/0111111 toLin, which is incorporated by reference herein in its entirety. In otherembodiments, the stent frame 36 need not be of a self-expandingconstruction. Regardless, the stent frame 36 can be formatted to assumea variety of different shapes in the normal, expanded conditioncorresponding to the native anatomy at which the prosthetic valve 30will be implanted and that may or may not be implicated by the generalshapes reflected in FIG. 1A (e.g., the prosthetic valves of the presentdisclosure need not have the stepped-down shape shown or can have a morecomplex shape).

The valve structure 38 can assume a variety of forms, and can be formed,for example, from one or more biocompatible synthetic materials,synthetic polymers, autograft tissue, homograft tissue, xenografttissue, or one or more other suitable materials. In some embodiments,the valve structure 38 can be formed, for example, from bovine, porcine,equine, ovine and/or other suitable animal tissues. In some embodiments,the valve structure 38 can be formed, for example, from heart valvetissue, pericardium, and/or other suitable tissue. Non-limiting examplesof prosthetic valves and/or prosthetic valve features that may be usedin accordance with one or more embodiments of the present disclosure aredescribed in U.S. patent application Ser. No. 14/175,100, filed Feb. 7,2014, entitled “HEART VALVE PROSTHESIS”, and which patent application ishereby incorporated by reference in its entirety to the extent that itdoes not conflict with the disclosure presented herein.

In some embodiments, the valve structure 38 can include or form one ormore leaflets 70. For example, the valve structure 38 can be in the formof a tri-leaflet bovine pericardium valve, a bi-leaflet valve, oranother suitable valve. In some constructions, the valve structure 38can comprise two or three leaflets that are fastened together atenlarged lateral end regions to form commissural joints, with theunattached edges forming coaptation edges of the valve structure 38. Theleaflets 70 can be fastened to a skirt that in turn is attached to thestent frame 36. The upper ends of the commissure points can define theinflow side 50. Regardless, the valve structure 38 transitions between aclosed state (reflected in FIG. 1A), in which the valve structure 38closes the lumen 44 and prevents fluid flow there through (e.g., fromthe outflow end 34 to the inflow end 32), and an open state shown inFIG. 2 (described in greater detail below), in which the valve structure38 permits fluid flow through the lumen 44 (e.g., from the inflow end 32to the outflow end 34).

The baffle structures of the present disclosure can assume a widevariety of forms, and includes at least one baffle member 80. In someembodiments, the baffle structure can include a plurality of bafflemembers, with FIG. 1A reflecting provision of first and second bafflemembers 80 a, 80 b for the vortical flow baffle structure 40 (it beingunderstood that three or more baffle members can be provided in yetother embodiments). Regardless of the number included, with optionalembodiments in which the vortical flow baffle structure 40 is provided(as in FIGS. 1A and 1B), the baffle member(s) 80 of the vortical flowbaffle structure 40 collectively serve to affect or influence fluid flowfrom the valve structure 38 as it progress from the outflow side 52,including creating or generating a velocity profile in the fluid flowexiting the outflow end 34 that is non-uniform, including a flow profilethat includes vortices (or “vortical flow”). In related embodiments, thevortical flow baffle structure 40 is configured to affect or create avortex ring or toroidal vortex in the fluid flow.

By way of further explanation with respect to the non-limitingembodiments in which the vortical flow baffle structure 40 is provided,FIG. 2 represents the prosthetic valve 30 implanted or located within ageneric bodily vessel 100. Fluid flow (e.g., blood flow, other liquidflow, air or other gas flow, etc.) within the vessel 100 is naturallydirected toward the inflow end 32, as identified by arrows BF_(I). Inthe view of FIG. 2, the valve structure 38 is an open state orcondition. The open state or condition can be achieved in variousmanners depending upon a particular construction of the prosthetic valve30. In some embodiments, the valve structure 38 has a passiveconfiguration, and naturally transitions to the open state when apressure at the inflow side 50 is greater than a pressure at the outflowside 52 (identified in FIG. 1A). Regardless, in the open state, thevalve structure 38 permits the fluid flow BF_(I) to pass through orbetween the leaflets 70, progressing from the outflow side 52 into theoutflow track 60. Fluid flow within the outflow track 60 upstream of thevortical flow baffle structure 40 is generally identified by arrowsBF_(T). Prior to interfacing with the vortical flow baffle structure 40,the fluid flow BF_(T) naturally has a relatively uniform velocityprofile corresponding with the native or natural fluid flow velocityprofile within the vessel 100 were the prosthetic valve 30 not present(e.g., may or may not be laminar flow, but does not include vortices orvortical flow). As the fluid flow progresses through the outflow track60 and interfaces with the vortical flow baffle structure 40, thevortical flow baffle structure 40 manipulates the fluid flow, such thatthe fluid flow exiting the outflow end 34 (identified the arrows BF_(O))includes vortices V. In some embodiments, the vortical flow bafflestructure 40 is configured to create a complex vortex arrangement in thefluid flow BF_(O) exiting the outflow end 34, as schematicallyillustrated by the arrows in FIG. 2. The so-induced flow or velocityprofile is or includes a vortex ring or toroidal vortex VR in anexemplary embodiment. In comparison, FIG. 3 illustrates a velocityprofile of fluid flow exiting a prosthetic valve PV that is otherwiseidentical to the prosthetic valve 30 of FIG. 2 except that the vorticalflow baffle structure 40 is omitted. The incoming fluid flow BF_(I) andthe fluid flow BF_(T) immediately downstream of the outflow side 52 (ofthe valve structure 38) are identical in both views. However, becausethe prosthetic valve PV of FIG. 3 does not include a baffle structureconfigured to overtly manipulate the fluid flow, the fluid flow exitingthe prosthetic valve PV has a relatively uniform flow velocity profile,and does not include any substantive vortices or vortex ring.

Returning to FIG. 2, and again with respect to non-limiting embodimentsin which the optional vortical flow baffle structure 40 is provided, itis recognized that a number of parameters can affect the profile offluid flow exiting the prosthetic valve 30 apart from the vortical flowbaffle structure 40. For example, the size (e.g., length and innerdiameter) of the stent frame 36, frictional attributes of the valvestructure 38, flow characteristics of the incoming fluid flow BF_(I) atthe particular native vessel, etc. The vortical flow baffle structures40 of some embodiments of the present disclosure are configured withthese other parameters in mind, functioning to cause a marked change inthe velocity profile in the fluid flow exiting the prosthetic valve 30,for example inducing vortical flow under circumstance where, but for thevortical flow baffle structure 40, substantive vortices V or the vortexring VR would not occur.

The baffle structures 40, 41, and in particular the baffle member(s) 80,of the present disclosure can assume a wide variety of forms. The bafflemember(s) 80 can be any device (e.g., a plate, wall, screen, partition,paddle, etc.) arranged within the outflow track 60 or downstream of theoutflow margin 46 of the stent frame 36 so as to deflect, check orregulate flow or passage of fluid (e.g., blood), but that does notentirely occlude fluid flow. For example, the baffle member(s) 80 can bea solid or perforated plate formed of a rigid, compliant orsemi-complaint biocompatible material. The baffle member(s) 80 can havea symmetric or asymmetric shape and can have a profile tailored togenerate the desired velocity profile, for example in accordance withthe expected conditions at the native vessel at which the prostheticvalve 30 is to be implanted. Further, a location of the baffle member(s)80 of the vortical flow baffle structure 40 relative to the valvestructure outflow side 52 (e.g., axial distance or spacing between theoutflow side 52 and the baffle member(s) 80) can also be tailored tooptimize the exiting fluid flow profile relative to the native anatomyat which the prosthetic valve 30 will be implanted. Where two (or more)of the baffle members 80 are provided, the baffle members 80 can haveidentical or differing shapes, can be asymmetric in shape and/or can bemounted to the stent frame 36 off-plane from one another. The bafflemember(s) 80 can be connected (directly or indirectly) to the stentframe 36 in various fashions, such as by an appropriate connectiondevice (e.g., elasticated sutures), welding, adhesive, etc.

In addition to material selection, profile shape and porosity, anability of the baffle member(s) 80 of the vortical flow baffle structure40 to, in some non-limiting embodiments, induce vortical flow at desiredlevels and with a desired shape (e.g., vortex ring or toroidal vortex)without overtly obstructing fluid flow is, in some embodiments, afunction of an extent to which the baffle member(s) 80 project across adiameter of the outflow track 60 (and thus project into the fluid flowprofile). More particularly, and with reference to the non-limitingexample of FIG. 1A, the outflow track 60 has a diameter D in the normal,expanded condition of the stent frame 36 (i.e., a diameter of the lumen44 downstream of the valve structure 38). Extension of each of the oneor more baffle members 80 of the vortical flow baffle structure 40includes a radial component relative to an axial center line of thestent frame 36. For example, in some embodiments, at least one of thebaffle members 80 extends in the radial direction across at least 10% ofthe outflow track diameter D, in other embodiments, at least 20%, and inyet other embodiments at least 30%. In related embodiments, the outflowtrack 60 can be described as defining an area in a plane perpendicularto a longitudinal axis of the stent frame 36. Relative to a planeperpendicular to the longitudinal axis and passing through one of thebaffle members 80, the baffle member 80 occupies at least 10% of theoutflow track area, in other embodiments at least 20%, and in yet otherembodiments at least 30%; in related embodiments, the baffle member 80occupies not more than 95% of the outflow track area, in otherembodiments not more than 90%, and in yet other embodiments not morethan 85%. Within these design parameters, the baffle member 80 isconfigured, in some non-limiting embodiments, to sufficiently interactwith fluid flow to induce vortical flow, but will not overtly obstructfluid flow to levels below the needs of the patient.

As indicated above, the prosthetic valves of the present disclosure caninclude a baffle structure configured or tailored to the particularnative valve being addressed, for example to effectuate a flow profileakin to or mimicking the native or natural flow profile otherwisenormally occurring at the native (healthy) valve anatomy in somenon-limiting embodiments. For example, in some embodiments theprosthetic valve of the present disclosure is intended to repair orreplace a native mitral valve. FIG. 4 illustrates one embodiment of aprosthetic mitral valve 200 in accordance with principles of the presentdisclosure that defines an inflow end 202 opposite an outflow end 204,and includes a stent frame 206, a valve structure 208 and a vorticalflow baffle structure 210 (referenced generally).

The stent frame 206 can have any of the constructions described above,and generally defines a lumen, an inflow margin 212 and an outflowmargin 214 opposite the inflow end 212. In the exemplary embodiment ofFIG. 4, the stent frame inflow and outflow margins 212, 214 serve as ordefine the inflow ends 202, 204, respectively, of the prosthetic valve200. The stent frame 206 optionally includes or forms additionalfeatures useful for connection to a delivery device, such as crowns oreyelets 216. Further, the stent frame 206 can optionally include orcarry additional support structures, such as one or more support arms218. The stent frame 206 may also be configured to provide axialfixation by creating tensioning of chordae tendinae of the native mitralvalve space.

The valve structure 208 (shown schematically in phantom) is disposedwithin the lumen and is configured to define an inflow side 220 and anoutflow side 222 opposite the inflow side 220. The valve structure 208can have any of the constructions described above and in someembodiments optionally is a uniform tricuspid valve structure, includingthree leaflets 226 (two of which are represented in FIG. 4).Alternatively, the valve structure 208 can provide more or less thanthree of the leaflets 226. Regardless, an outflow track 230 (referencedgenerally) is established within the lumen downstream of the outflowside 222 and along which fluid flow (e.g., blood flow) from the valvestructure 208 progresses following implant.

The vortical flow baffle structure 210 is connected to the stent frame206 and optionally projects into the outflow track 230 in someembodiments. With the exemplary embodiment of FIG. 4, the vortical flowbaffle structure 210 includes first and second baffle members 240, 242.The baffle members 240, 242 can each assume any of the forms describedabove and are longitudinally or axially spaced from one another. Thebaffle members 240, 242 can project from diametrically opposite sides ofthe stent frame 206, each optionally extending across at least 10%, andless than 90%, of a diameter of the outflow track 230 as describedabove. Further, a gap 244 is established between the baffle members 240,242 through which fluid flow can readily occur from the outflow side 222of the valve structure 204 to (and outwardly from) the outflow end 204.

The stent frame 206 is sized and shaped (in the natural, expanded stateof FIG. 4) in accordance with the native anatomy for replacing orrepairing a mitral valve. As a point of reference, FIG. 5 illustrates aportion of a heart H including a left atrium LA, a left ventricle LV, amitral space MV and an aortic valve AV. The mitral space MV includes ananterior leaflet AL and a posterior leaflet PL. Blood flow BF isdepicted with directional arrows in FIG. 5 in the left atrium LA, intothe left ventricle LV through the mitral valve space MV, and into theaorta through the aortic valve AV. When the native mitral valve isoperating properly, the native leaflets AL, PL will generally functionin such a way that blood flows toward the left ventricle LV when theleaflets AL, PL are in an open position, and so that blood is preventedfrom moving toward the left atrium LA when the leaflets AL, PL are in aclosed position. As shown, the anterior leaflet AL (along with otheranatomical features such as the mitral valve's coaptation mechanism) ofa healthy native mitral valve naturally induces vortical flow into theblood flow BF as it enters the left ventricle LV in a direction of anapex A of the left ventricle LV, the flow profile including vortices V.The blood flow BF at the left ventricle LV often has a complex vortexarrangement, including a vortex ring or toroidal vortex VR (referencedgenerally).

FIG. 6 illustrates the prosthetic valve 200 following placement orimplant within the mitral space MV. The prosthetic valve 200 can bedelivered via a transcatheter or percutaneous approach, including theprosthetic valve 200 being compressed within a delivery device, trackedthrough the patient's vasculature to the mitral space MV, and thencaused to expand (e.g., self-expansion or forced expansion such as witha balloon as is known in the art) within the mitral space MV.Transcatheter delivery devices useful with the prosthetic valves of thepresent disclosure can have a known or conventional form generallyproviding a retractable outer sheath for releasably containing thecompressed prosthetic valve, an inner shaft or tube for supporting thecompressed prosthetic valve, and optionally having additional componentssuch as any of the components described, for example, in Yeung et al.,U.S. Publication No. 2011/009880; Duffy et al., U.S. Publication No.2012/0041547; Murray et al., U.S. Publication No. 2012/0310332, theentire teachings of each of which are incorporated herein by reference.

Following placement at the mitral space MV (in which the prostheticvalve 200 may push the native leaflets AL, PL out of the mitral spaceMV, or the native leaflets can be surgically removed), the prostheticvalve 200 functions to permit blood flow from the left atrium LA to theleft ventricle LV when the valve structure 208 is in the open state, andto prevent blood flow from the left ventricle LV to the left atrium LAwhen the valve structure 208 is in the closed state. Blood flow in thevalve open state is illustrated by arrows BF as progressing from theleft atrium LA, through the prosthetic valve 200, and into the leftventricle LV. In this regard, as the blood flow progresses along theoutflow track 230, the vortical flow baffle structure 210 (referencedgenerally) manipulates the otherwise relatively uniform flow profile andinduces vortices into the flow. More particularly, blood flow exitingthe outflow end 204 has a vortical flow or velocity profile, includingmultiple vortices (represented by the arrows V in FIG. 6). In someembodiments, the blood flow exiting the outflow end has a complex vortexarrangement, including a vortex ring or toroidal vortex VR (referencedgenerally). The vortical flow into the left ventricle LV can have acircular-type flow component as it reaches and interfaces with the apexA (FIG. 5) of the left ventricle LV. It is believed these vortices Vhelp synchronize the heart beat and aid in efficient ventricularejection. In some embodiments, the vortical flow baffle structure 210 isconfigured (e.g., construction, location, etc.) to manipulate at least10% of the blood flow progressing through the outflow track 230, suchthat at least 10% of the blood flow exiting the outflow end 204 exhibitsvertical flow.

The vortical flow effectuated by the prosthetic valve 200 attempts tomimic the natural velocity flow profile generated by a natural, healthymitral valve as evidenced by a comparison of FIGS. 5 and 6. However, theprosthetic valve 200 optionally incorporates a tricuspid leaflet valvestructure (with the three leaflets optionally being relatively uniform)construction that differs significantly from the asymmetric, bicuspidform of the native mitral valve. Thus, the prosthetic valve 200 can moreeasily be delivered and located via a transcatheter approach (ascompared to a prosthetic mitral valve incorporating an asymmetrical, twoleaflet valve structure), while at the same time effectuating a desiredvortical blood flow profile. By way of further comparison, FIG. 7illustrates the heart H with a conventional prosthetic mitral valve PV(i.e., does not include the baffle structure of the present disclosure)implanted to the mitral space MV. The blood flow exiting the prostheticvalve PV has a relatively uniform velocity profile, with insignificant,if any, vortices.

The vortical flow baffle structure 210 described above is but oneexample of a baffle structure in accordance with principles of someembodiments of the present disclosure configured to induce or createvortical flow, for example including a vortex ring or toroidal vortex.For example, FIG. 8 illustrates another prosthetic valve 250 inaccordance with principles of the present disclosure, and defines aninflow end 252 opposite an outflow end 254. The prosthetic valve 250includes a stent frame 256, a valve structure 258 and a vortical flowbaffle structure 260 (referenced generally).

The stent frame 256 and the valve structure 258 can have any of theconfigurations described elsewhere in this disclosure, and are in no waylimited to the constructions possibly implicated by the view of FIG. 8.For example, a shape of the stent frame 256 in the normal, expandedcondition can be appropriate for deployment at a native mitral valveanatomy, or alternatively, would be shaped in accordance with any otherinternal anatomy of the human body. Regardless, the stent frame 256generally defines a lumen, an inflow margin 262 and an outflow margin264 opposite the inflow margin 262. In the exemplary embodiment of FIG.8, the stent frame inflow and outflow margins 262, 264 serve as ordefine the inflow and outflow ends 252, 254, respectively, of theprosthetic valve 250. Alternatively, a portion of the vortical flowbaffle structure 260 can project beyond the outflow margin 264 to definethe outflow end 254. The valve structure 258 (drawn schematically inphantom) is disposed within the stent frame lumen, and is configured toprovide an inflow side 270 and an outflow side 272 opposite the inflowside 270. An outflow track 280 (referenced generally) is establishedwithin the lumen downstream of the outflow side 272 and along whichfluid flow from the valve structure 254 progresses following implant.

The vortical flow baffle structure 260 is connected to the stent frame256 and optionally projects into the outflow track 280. With theexemplary embodiment of FIG. 8, the vortical flow baffle structure 260includes first and second baffle members 290, 292. In other embodiments,a single one, or more than two, of the baffle members 290, 292 areprovided. The baffle members 290, 292 can have any of the formsdescribed above (e.g., solid plate, perforated plate, rigid material,flexible material, etc.). The baffle members 290, 292 can belongitudinally aligned (relative to a longitudinal axis of the stentframe 256) and can be shaped to extend from the stent frame 256 in agenerally downstream direction. The baffle members 290, 292 can beidentical or can differ in terms of at least shape or size, and can eachoptionally extend across at least 10%, and less than 90%, of a diameterof the outflow track 280.

Following implant, the prosthetic valve 250 functions in accordance withthe above descriptions, with the valve structure 258 transitioningbetween open and closed states. As fluid flow progresses from theoutflow side 272, the fluid flow interfaces with the vortical flowbaffle structure 260. The vortical flow baffle structure 260 inducesvortices into the fluid flow as the fluid flow exits the outflow end 254commensurate with the above descriptions, optionally creating a vortexring or toroidal vortex in the exiting fluid flow.

Another embodiment prosthetic valve 300 in accordance with principles ofthe present disclosure is shown in FIG. 9. The prosthetic valve 300defines an inflow end 302 opposite an outflow end 304, and includes astent frame 306, a valve structure 308 and a vortical flow bafflestructure 310 (referenced generally).

The stent frame 306 and the valve structure 308 can have any of theconfigurations described elsewhere in this disclosure, and are in no waylimited to the constructions possibly implicated by the view of FIG. 9.For example, a shape of the stent frame 306 in the normal, expandedcondition can be appropriate for deployment at a native mitral valveanatomy, or alternatively could be shaped in accordance with any otherinternal anatomy of the human body. Regardless, the stent frame 302generally defines a lumen, an inflow margin 312 and an outflow margin314 opposite the inflow margin 312. The valve structure 308 (drawnschematically in phantom) is disposed within the stent frame lumen, andis configured to provide an inflow side 320 opposite an outflow side322. An outflow track 330 (referenced generally) is established withinthe lumen downstream of the outflow side 322 and along with fluid flowfrom the valve structure 308 progresses following implant.

The vortical flow baffle structure 310 is connected to the stent frame302. With the exemplary embodiment of FIG. 9, the baffle structure 306includes first and second baffle members 340, 342. In other embodiments,a single one, or more than two, of the baffle members 340, 342 areprovided. The baffle members 340, 342 can have any of the formsdescribed above (e.g., solid plate, perforated plate, rigid material,flexible material, etc.). In some embodiments, the baffle members 340,342 can have a similar, or even identical, shape, for example thepaddle-like shape illustrated in FIG. 9. The baffle members 340, 342 caneach include or define a post 350 and a head 352. The optionalpaddle-like shape is generated by a width of at least a portion of thehead 352 being greater than a width of the post 350. The post 350 ispivotably coupled to the stent frame 306, with the head 352 beingmovable relative to the stent frame 306 with pivoting of the post 350(represented by arrows in FIG. 9). Coupling between the post 350 and thestent frame 306 and/or a construction of the baffle members 340, 342optionally biases the baffle members 340, 342 to a particularorientation relative to the stent frame 306.

In some embodiments, the post 350 is connected to the stent frame 306 ator in close proximity to the outflow margin 314. With this construction,the corresponding head 352 can be located away from, or downstream of,the outflow margin 314 of the stent frame 306 as shown. While the bafflemembers 340, 342 can, in some embodiment, sufficiently pivot or rotateto bring the corresponding head 352 into the lumen of the stent frame306, with some embodiments of the present disclosure, including those ofFIG. 9, the vortical flow baffle structure 310 effectively defines theoutflow end 304 of the prosthetic valve 300 (i.e., the last structure orbody of the prosthetic heart valve 300 that interfaces with fluidflowing in the outflow or downstream direction).

Following implant, the prosthetic valve 300 functions in accordance withthe above descriptions, including the valve structure 308 transitioningbetween open and closed states. As fluid progresses from the outflowside 322 of the valve structure 308, the fluid flow interfaces with thevortical flow baffle structure 310. In this regard, the baffle members340, 342 can naturally move or pivot into the fluid flow path as itexits the outflow margin 314 of the stent frame 306 or can be biased tothis position. Regardless, the vortical flow baffle structure 310induces vortices into the fluid flow as the fluid flow progresses beyondor downstream of the outflow end 304 commensurate with the abovedescriptions, optionally creating a vortex ring or toroidal vortex inthe exiting fluid flow.

Another embodiment prosthetic valve 400 in accordance with principles ofthe present disclosure is shown in FIG. 10. The prosthetic valve 400defines an inflow end 402 opposite an outflow end 404, and includes astent frame 406, a valve structure 408 and a vortical flow bafflestructure 410.

The stent frame 406 and the valve structure 408 can have any of theconfigurations described elsewhere in this disclosure, and are in no waylimited to the constructions possibly implicated by the view of FIG. 10.For example, a shape of the stent frame 406 in the normal, expandedcondition can be appropriate for deployment at a native mitral valveanatomy, or alternatively could be shaped in accordance with any otherinternal anatomy of the human body. Regardless, the stent frame 406generally defines a lumen, an inflow margin 412 and an outflow margin414 opposite the inflow margin 412. The valve structure 408 (drawnschematically in phantom) is disposed within the stent frame lumen, andis configured to provide an inflow side 420 opposite an outflow side422. An outflow track 430 (referenced generally) is established withinthe lumen downstream of the outflow side 422 and along with fluid flowfrom the valve structure 408 progresses following implant.

The vortical flow baffle structure 410 is connected to the stent frame406. With the exemplary embodiment of FIG. 10, the vortical flow bafflestructure 410 includes a baffle member 440 in the form of a sleeve orcowl. The baffle member 440 can be formed of a mesh or solid material,and forms at least one side 442 to have a curvature that projects intothe fluid flow path exiting the outflow margin 414 of the stent frame406. Thus, with the embodiment of FIG. 10, the vortical flow bafflestructure 410 defines the outflow end 404 of the prosthetic heart valve400 (i.e., the last or downstream-most structure of the prosthetic heartvalve 400 that interfaces with fluid flowing in the outflow ordownstream direction).

Following implant, the prosthetic valve 400 functions in accordance withthe above descriptions, including the valve structure 408 transitioningbetween open and closed states. As fluid progresses from the outflowside 422 of the valve structure 408, the fluid flow interfaces with thevortical flow baffle structure 410. More particularly, the baffle member440 projects into the fluid flow path as it exits the outflow margin 414of the stent frame 406. The vortical flow baffle structure 410 inducesor creates vortices into the fluid flow progressing beyond or downstreamof the outflow end 404 commensurate with the above descriptions,optionally creating a vortex ring or toroidal vortex in the fluid flow.

Returning to FIG. 1C, the while some embodiments of the presentdisclosure include a vortical flow baffle structure, other embodimentprosthetic valves of the present disclosure incorporate a bafflestructure in the form of a laminar flow baffle structure, such as thelaminar flow baffle structure 41 shown for the prosthetic valve 30′. Thelaminar flow baffle structure 41 can be located more proximate theoutflow side 52 (as compared to the vortical flow baffle structuresdescribed above) and is configured to modify or manipulate blood flowlocally through the lumen 42 at the outflow track 60 to target areasthat might otherwise be subject to stagnant or turbulent flow were thelaminar flow baffle structure 41 not present. With these embodiments,the laminar flow baffle structure 41 serves to modify blood flow toreduce or eliminate turbulent regions in and around the prosthetic valve30′ (that might otherwise occur were the inflow baffle structure 41 notpresent), directing the blood flow into designated areas in order tocreate laminar or near-laminar flow. Presence of the laminar flow bafflestructure 41 may or may not affect a flow profile at the outlet end 34(as compared to a flow profile were the laminar flow baffle structure 41not present), and may or may not contribute to formation of vortices atthe outlet end 34.

The baffle member(s) 80′ provided with the laminar flow baffle structure41 can assume a variety of forms, including any of the forms describedfor the vortical flow baffle structures above. For example, in someembodiments, the baffle members 80′ of the laminar flow baffle structure41 can be akin to paddles, the shape and location of which can beoptimized (e.g., in terms of effectuating desired flow pattern orprofile immediately downstream of the outflow side 52) using fluid flowmodeling. The baffle member(s) 80′ can be incorporated into the stentframe 36 (e.g., during a laser cut process) and optionally shape set ata desired angular orientation (e.g., where the stent frame 36 is formedof a shape memory material such as Nitonol™). Alternatively, the bafflemember(s) 80′ can be formed apart from the stent frame 36 and attachedthereto, such as from a polymer or fabric material. With these and otheroptional embodiments, the baffle member(s) 80′ can be attached (e.g.,sewn) to the stent frame 36 during the fabrication process.

With the above descriptions of the laminar flow baffle structure 41 inmind, FIGS. 11A and 11B illustrates another prosthetic valve 500 inaccordance with principles of the present disclosure that defines aninflow end 502 opposite an outflow end 504. The prosthetic valve 500includes a stent frame 506, a valve structure 508 and a laminar flowbaffle structure 510 (referenced generally).

The stent frame 506 and the valve structure 508 can have any of theconfigurations described elsewhere in this disclosure, and are in no waylimited to the constructions possibly implicated by the views of FIGS.11A and 11B. For example, a shape of the stent frame 506 in the normal,expanded condition can be appropriate for deployment at a native aorticvalve anatomy, mitral valve anatomy, or alternatively, would be shapedin accordance with any other internal anatomy of the human body.Regardless, the stent frame 506 generally defines a lumen, an inflowmargin 512 and an outflow margin 514 opposite the inflow margin 512. Inthe exemplary embodiment of FIGS. 11A and 11B, the stent frame inflowand outflow margins 512, 514 serve as or define the inflow and outflowends 502, 504, respectively, of the prosthetic valve 500. The valvestructure 508 is disposed within the stent frame lumen, and isconfigured to provide an inflow side 520 (referenced generally) and anoutflow side 522 (referenced generally) opposite the inflow side 520. Anoutflow track 530 (referenced generally) is established within the lumendownstream of the outflow side 522 and along which fluid flow from thevalve structure 504 progresses following implant.

The laminar flow baffle structure 510 is connected to the stent frame506 and optionally projects into the outflow track 530. With theexemplary embodiment of FIGS. 11A and 11B, the laminar flow bafflestructure 510 includes a plurality of baffle members 540 disposed aboutan inner circumference of the stent frame 506. In other embodiments, asingle one of the baffle members 540 is provided. The baffle members 540can have any of the forms described above (e.g., solid plate or paddle,perforated paddle, rigid material, flexible material, etc.), and aresized, shaped and spatially oriented to encourage laminar or nearlylaminar flow into the flow profile of blood as it exits the outflow side522 of the valve structure 508. For example, the baffle members 540 canbe equidistantly disposed about a circumference of the stent frame 506,or can be non-uniformly distributed. In some embodiments, some or all ofthe baffle members 540 longitudinally aligned (relative to alongitudinal axis A of the stent frame 506); in other embodiments, thebaffle members 506 can be arranged to define a spiral-like pattern aboutthe longitudinal axis A. Regardless, one or more of the baffle members540 project inwardly from the stent frame 506 at an angular orientationrelative to the longitudinal axis A as best reflected by FIG. 11B. Forexample, in some embodiments, a shape of each of the baffle members 540defines a major plane, such as a major plane P identified for a firstbaffle member 540 a in FIG. 11B. One, some or all of the baffle members540 are arranged such that the major plane P is off-set from orotherwise does not intersect the longitudinal axis A (e.g., the bafflemember(s) 540 does not project from the stent frame 506 in only a radialdirection). The angular relationship of each the baffle members 540relative to the longitudinal axis A can be substantially identical insome embodiments, and is selected to encourage a laminar or nearlylaminar flow profile into blood flow exiting the outflow side 522 of thevalve structure 508. As the blood flow then progresses along the outflowtrack 530 and interfaces with the stent frame 506, occurrences ofstagnant or turbulent flow at the stent frame 506 and surrounding areasis reduced or eliminated (as compared to a flow profile in the absenceof the laminar flow baffle structure 510). Other geometry features canbe incorporated into one or more of the baffle members 540 that furtherencourage or promote a desired flow profile, such as curvature formed ata leading edge 550 (identified for a second baffle member 540 b in FIGS.11A and 11B). The baffle members 540 can be identical or can differ interms of at least shape or size, and can each optionally extend acrossat least 5%, and less than 90%, of a diameter of the outflow track 280.

With the exemplary constructions of at least FIGS. 6 and 8-10, theprosthetic heart valve 200 is optionally configured (e.g., sized andshaped) for replacing or repairing a mitral valve. Alternatively, othershapes are also envisioned, adapted to mimic the specific anatomy of thevalve to be repaired (e.g., stented prosthetic heart valves useful withthe present disclosure can alternatively be shaped and/or sized forreplacing a native aortic, pulmonic or tricuspid valve, or useful as anintraluminal valve away from the heart). For example, the prostheticvalves of the present disclosure can be configured for placement in theurinary track (to regulate flow or urine), in the lung (to regulate flowof gas), etc. The baffle structures of the present disclosure can beincorporated into prosthetic valves optionally having one or moreadditional features as described below.

One or more prosthetic valve embodiments disclosed herein may compriseno support arms, a single support arm, a plurality of support arms,support arms with inner and outer support arm members, variations ofstructures thereof, and/or one more pairs of support arms having variousstructures and attachment points for providing various functions whenimplanted. It should be understood that the illustrated embodimentshereof are not limited to the number or configuration of support armsillustrated in each figure and that one or more support arms, one ormore pairs of support arms and/or the various structures therefore maybe substituted across the various embodiments disclosed herein withoutdeparting from the scope hereof.

In one or more embodiments, the prosthetic valves of the presentdisclosure may comprise one or more support arms for engaging one ormore native valve leaflets. In one or more embodiments, valve prosthesismay comprise one or more support arms for engaging one or more nativechordae. In one or more embodiments, the prosthetic valve may compriseone or more support arms for engaging one or more native valvecommissures. In one or more embodiments, the prosthetic valve maycomprise one or more support arms for engaging a native valve annulus.In one or more embodiments, prosthetic valve may comprise one or moresupport arms for engaging one or more native valve tissues orstructures. For example, one or more support arms may engage or interactwith valve leaflets, chordae, commissures and/or annulus. In one or moreembodiments, the prosthetic valve may comprise one or more support armsfor engaging one or more heart tissues or structures. In one or moreembodiments, the prosthetic valve may comprise one or more support armsfor engaging the pulmonary artery. In one or more embodiments, theprosthetic valve may comprise one or more support arms for engaging theaorta.

In one or more embodiments, one or more support arms may be coupled orconnected to a central portion, an inflow portion and/or an outflowportion of the prosthetic valve. In one or more embodiments, theprosthetic valve may comprise one or more support arms that may applyone or more forces such as a radial force, an axial force, a lateralforce, an inward force, an outward force, an upstream force, and/or adownstream force to one or more valve structures, valve tissues, heartstructures and/or heart tissues. In some embodiments, one or moresupport arms, as described herein, may be considerably longer, shorter,wider, or narrower than shown. In some embodiments, one or more supportarms, as described herein, may be narrower at the base, bottom orproximal end portion where the support arms couple to an inflow portion,central portion and/or an outflow portion of the prosthetic valve andwider at the top or distal end portion of the support arm. In someembodiments, one or more support arms, as described herein, may be widerat the base, bottom, or proximal end portion where the support armscouple to the inflow portion, central portion and/or the outflow portionof the prosthetic valve and narrower at the top or distal end portion ofthe support arm. In some embodiments, one or more support arms, asdescribed herein, may be configured to be a shape and size that canprovide a positioning function, valve leaflet capturing function, astabilization function, an anti-migration function, and/or an anchoringfunction for valve prosthesis in accordance herewith when the prosthesisis deployed at a native valve site. In some embodiments, one or moresupport arms, as described herein, may interact, engage, capture, clamp,push against one or more native tissues or structures such as valveleaflets, chordae, annulus, ventricle, and/or atrium. In someembodiments, one or more support arms, as described herein, may comprisea first portion that extends in a forward direction and a second portionthat extends in a backward direction. In some embodiments, one or moresupport arms, as described herein, may comprise a first portion thatextends in a backward direction and a second portion that extends in aforward direction. In some embodiments, one or more support arms, asdescribed herein, may comprise one or more portions that may extendhorizontally, longitudinally, axially, circumferentially, inward,outward, forward, and/or backward. In some embodiments, one or moresupport arms, as described herein, may comprise more than oneconfiguration. For example, one or more embodiments of one or moresupport arms, as described herein, may extend in first direction in adelivery, compressed, and/or collapsed configuration and in a seconddirection in a deployed or expanded configuration. In one example, afirst or delivery direction may be a forward direction and a second ordeployed direction may be a backward direction. In another example, afirst or delivery direction may be a backward direction and a second ordeployed direction may be a forward direction. In one or moreembodiments, one or more support arms, as described herein, may comprisea first shape in a delivery configuration and a second shape in adeployed configuration. For example, a first or delivery shape may be astraight shape and a second or deployed shape may be a curved shape.

In some embodiments, one or more support arms, as described herein, maycomprise one or more portions that comprise one or more spiral shapes,s-shapes, c-shapes, u-shapes, V-shapes, loop shapes, tine shapes, and/orprong shapes. In some embodiments, one or more support arms, asdescribed herein, may comprise a curved, rounded, and/or flared distalend portion. In some embodiments, one or more support arms, as describedherein, may be connected, coupled, attached, and/or extend from one ormore locations positioned on the inflow portion, the central portionand/or the outflow portion of the prosthetic valve. For example, in someembodiments, one or more support arms, as described herein, may beconnected, coupled, attached, and/or extend from one or more locationspositioned on the inflow portion, the central portion and/or the outflowportion of the valve prosthesis stent frame support structure. In someembodiments, one or more support arms, as described herein, may compriseat least a portion that may comprise at least one free end not attachedor coupled to the stent frame of the prosthetic valve. In one or moreembodiments, one or more support arms and/or one or more of componentsof a support arm may comprise one or more fixation elements or memberssuch as anchors, barbs, prongs, clips, grommets, sutures, and/or screws.In one or more embodiments, one or more support arms and/or one or moreof components of a support arm may comprise, for example, one or moreactive and/or passive fixation elements or members.

In one or more embodiments, the prosthetic valve may comprise an inflowportion, a central portion, and an outflow portion. In one or moreembodiments, the prosthetic valve may comprise a single unitarystructure or the prosthetic valve may comprise one or more components orportions coupled or connected together. In one or more embodiments, theprosthetic valve may comprise a central portion comprising a valve body,member, or component. In one or more embodiments, the valve body,structure, member, or component may comprise one or more valve leaflets.In one or more embodiments in accordance herewith, the valve leaflets ofthe valve body, structure, member, or component are attached to anupstream end of the central portion to extend into an inflow portion ofthe frame, such that the valve body, structure, member, or component isnot solely located on or within the outflow portion of the frame. In oneor more embodiments, valve member and/or one or more of its componentsmay comprise one or more materials, as described herein.

In one or more embodiments, the central portion of the prosthetic valveand/or one or more of its components may comprise one or morelongitudinal or cross-sectional shapes, such as a geometric shape, anon-geometric shape, a tubular shape, a cylindrical shape, a circularshape, an elliptical shape, an oval shape, a triangular shape, arectangular shape, a hexagonal shape, a square shape, an hourglassshape, a polygonal shape, a funnel shape, a nozzle shape, a D-shape, asaddle shape, a planar shape, a non-planar shape, a simple geometricshape, and/or a complex geometric shape. In one or more embodiments, thecentral portion and/or one or more of its components may comprise one ormore fixation elements or members such as anchors, barbs, clips, prongs,grommets, sutures, and/or screws. In one or more embodiments, thecentral portion and/or one or more of its components may comprise aframe, a framework, or stent-like structure, as described herein. In oneor more embodiments, the outflow portion and/or one or more of itscomponents may comprise, be covered with, be coated with, or be attachedor coupled to one or more materials, as described herein. In one or moreembodiments, the central portion and/or one or more of its componentsmay comprise one or more support arms, components, or members asdescribed herein. In one or more embodiments, one or more support armsmay comprise one or more cantilever components or portions. In one ormore embodiments, the central portion and/or one or more of itscomponents, such as one or more support arms, may be designed to engageand/or push against the native valve annulus. In one or moreembodiments, the central portion and/or one or more of its components,such as one or more support arms, may be designed to engage, capture,clamp, hold, and/or trap one or more native valve leaflets. In one ormore embodiments, the central portion and/or one or more of itscomponents, such as one or more support arms, may be designed to engage,capture, clamp, hold, and/or trap one or more native chordae. In one ormore embodiments, one or more support arms may create or exert a tensionforce to native chordae. In one or more embodiments, the central portionand/or one or more of its components, such as one or more support arms,may be designed to engage and/or push against one or more native valvecommissures.

In one or more embodiments, the prosthetic valve may comprise an inflow,inlet, upstream, or proximal portion connected, coupled, positioned,and/or located at a proximal end or proximal end portion of the centralportion of the valve prosthesis. In one or more embodiments, the inflowportion and/or one or more of its components may contact, engage,fixate, capture, clamp, pierce, hold, position, and/or seal theprosthetic valve to one or more heart structures and/or tissues such asatrial tissue, ventricle tissue, valve tissue, annulus tissue, the floorof an atrium, and/or the floor of a ventricle. For example, the inflowportion and/or one or more of its components may engage atrial tissue ifthe prosthetic valve is positioned in a native mitral valve whereas theinflow portion and/or one or more of its components may engage ventricletissue if the valve prosthesis is positioned in a native aortic valve.In one or more embodiments, the inflow portion and/or one or more of itscomponents may exert one or more forces, for example, radial and/oraxial forces, to one or more heart structures and/or heart tissues. Inone or more embodiments, the inflow portion and/or one or more of itscomponents may comprise one or more fixation elements or members such asanchors, barbs, clips, prongs, grommets, sutures, and/or screws. In oneor more embodiments, the inflow portion and/or one or more of itscomponents may comprise one or more longitudinal or cross-sectionalshapes, such as a geometric shape, a non-geometric shape, a tubularshape, a cylindrical shape, a circular shape, an elliptical shape, anoval shape, a triangular shape, a rectangular shape, a hexagonal shape,a square shape, a polygonal shape, a funnel shape, a nozzle shape, aD-shape, an S-shape, a saddle shape, a simple geometric shape, and/or acomplex geometric shape. In one or more embodiments, the inflow portionand/or one or more of its components may be designed to deform to theshape of the native anatomy when the prosthetic valve is implanted. Forexample, the inflow portion may deform from a pre-delivery circularshape to a post-delivery D-shape following the delivery of theprosthetic valve to a native mitral valve. In one or more embodiments,the inflow portion and/or one or more of its components may comprise aframe, a framework, or stent-like structure, as described herein. In oneor more embodiments, the inflow portion and/or one or more of itscomponents may comprise, be covered with, be coated with, or be attachedor coupled to one or more materials, as described herein. In one or moreembodiments, the inflow portion and/or one or more of its components maycomprise one or more support arms, components, or members as describedherein. In one or more embodiments, one or more support arms maycomprise one or more cantilever components or portions. In one or moreembodiments, the inflow portion and/or one or more of its components,such as one or more support arms, may be designed to engage and/or pushagainst the native valve annulus. In one or more embodiments, the inflowportion and/or one or more of its components, such as one or moresupport arms, may be designed to engage, capture, clamp, hold, and/ortrap one or more native valve leaflets. In one or more embodiments, theinflow portion and/or one or more of its components, such as one or moresupport arms, may be designed to engage, capture, clamp, hold, and/ortrap one or more native chordae. In one or more embodiments, one or moresupport arms may create or exert a tension force to native chordae. Inone or more embodiments, the inflow portion and/or one or more of itscomponents, such as one or more support arms, may be designed to engageand/or push against one or more native valve commissures.

In one or more embodiments, the prosthetic valve may comprise anoutflow, outlet, downstream, or distal portion connected, coupled,positioned, and/or located at a distal end or distal end portion of thecentral portion of the prosthetic valve. In one or more embodiments, theoutflow portion and/or one or more of its components may contact,engage, fixate, capture, clamp, pierce, hold, position, and/or seal thevalve prosthesis to one or more heart structures and/or tissues such asatrial tissue, ventricle tissue, valve tissue, valve leaflet tissue,annulus tissue, and/or chordae tissue. For example, the outflow portionand/or one or more of its components may engage leaflet tissue, chordaetissue, and/or ventricle tissue if the valve prosthesis is positioned ina native mitral valve whereas the outflow portion and/or one or more ofits components may engage leaflet tissue and/or aortic tissue if thevalve prosthesis is positioned in a native aortic valve. In one or moreembodiments, the outflow portion and/or one or more of its componentsmay exert one or more forces, for example, radial and/or axial forces,to one or more heart structures and/or heart tissues. In one or moreembodiments, the outflow portion and/or one or more of its componentsmay comprise one or more fixation elements or members such as anchors,barbs, prongs, clips, grommets, sutures, and/or screws. In one or moreembodiments, the outflow portion and/or one or more of its componentsmay comprise one or more longitudinal or cross-sectional shapes, such asa geometric shape, a non-geometric shape, a tubular shape, a cylindricalshape, a circular shape, an elliptical shape, an oval shape, atriangular shape, a rectangular shape, a hexagonal shape, a squareshape, a polygonal shape, a funnel shape, a nozzle shape, a D-shape, anS-shape, a saddle shape, a simple geometric shape, and/or a complexgeometric shape. In one or more embodiments, the outflow portion and/orone or more of its components may be designed to deform to the shape ofthe native anatomy when the prosthetic valve is implanted. For example,the outflow portion may deform from a pre-delivery circular shape to apost-delivery D-shape following the delivery of the prosthetic valve toa native mitral valve. In one or more embodiments, the outflow portionand/or one or more of its components may comprise a frame, a framework,or stent-like structure, as described herein. In one or moreembodiments, the outflow portion and/or one or more of its componentsmay comprise, be covered with, be coated with, or be attached or coupledto one or more materials, as described herein. In one or moreembodiments, the outflow portion and/or one or more of its componentsmay comprise one or more support arms, components, or members asdescribed herein. In one or more embodiments, the outflow portion and/orone or more of its components, such as one or more support arms, may bedesigned to engage, capture, clamp, hold, and/or trap one or more nativevalve leaflets. In one or more embodiments, the outflow portion and/orone or more of its components, such as one or more support arms, may bedesigned to engage, capture, clamp, hold, and/or trap one or more nativechordae. In one or more embodiments, one or more support arms may createor exert a tension force to native chordae. In one or more embodiments,the outflow portion and/or one or more of its components, such as one ormore support arms, may be designed to engage and/or push against one ormore native valve commissures. In one or more embodiments, the outflowportion and/or one or more of its components, such as one or moresupport arms, may be designed to engage and/or push against the nativevalve annulus. In one or more embodiments, one or more support arms maycomprise one or more cantilever components or portions.

In one or more embodiments, the prosthetic valve and/or one or more ofits components or portions may comprise, be covered with, be coatedwith, or be attached or coupled to one or more biocompatible materialsor biomaterials, for example, titanium, titanium alloys, Nitinol, TiNialloys, shape memory alloys, super elastic alloys, aluminum oxide,platinum, platinum alloys, stainless steels, stainless steel alloys,MP35N, elgiloy, haynes 25, stellite, pyrolytic carbon, silver carbon,glassy carbon, polymers or plastics such as polyamides, polycarbonates,polyethers, polyesters, polyolefins including polyethylenes orpolypropylenes, polystyrenes, polyurethanes, polyvinylchlorides,polyvinylpyrrolidones, silicone elastomers, fluoropolymers,polyacrylates, polyisoprenes, polytetrafluoroethylene, polyethyleneterephthalates, fabrics such as woven fabrics, nonwoven fabrics, porousfabrics, semi-porous fabrics, nonporous fabrics, Dacron fabrics,polytetrafluoroethylene (PTFE) fabrics, polyethylene terephthalate (PET)fabrics, materials that promote tissue ingrowth, rubber, minerals,ceramics, hydroxapatite, epoxies, human or animal protein or tissue suchas collagen, laminin, elastin or fibrin, organic materials such ascellulose, or compressed carbon, and/or other materials such as glass,and the like. Materials that are not considered biocompatible may bemodified to become biocompatible by a number of methods well known inthe art. For example, coating a material with a biocompatible coatingmay enhance the biocompatibility of that material. Biocompatiblematerials or biomaterials are usually designed and constructed to beplaced in or onto tissue of a patient's body or to contact fluid of apatient's body. Ideally, a biocompatible material or biomaterial willnot induce undesirable reactions in the body such as blood clotting,tumor formation, allergic reaction, foreign body reaction (rejection) orinflammatory reaction; will have the physical properties such asstrength, elasticity, permeability, and flexibility required to functionfor the intended purpose; may be purified, fabricated and sterilizedeasily; will substantially maintain its physical properties and functionduring the time that it remains in contact with tissues or fluids of thebody.

In one or more embodiments, the prosthetic valve and/or one or more ofits components or portions may comprise and/or be coupled or attached toone or more graft materials. In accordance with embodiments hereof, thegraft material or portions thereof may be a low-porosity woven fabric,such as polyester, DACRON® polyester, or polytetrafluoroethylene (PTFE),which creates a one-way fluid passage when attached to the stent frameof the valve prosthesis. In an embodiment, the graft material orportions thereof may be a looser knit or woven fabric, such as apolyester or PTFE knit, which can be utilized when it is desired toprovide a medium for tissue ingrowth and the ability for the fabric tostretch to conform to a curved surface. In another embodiment, polyestervelour fabrics may alternatively be used for the graft material orportions thereof, such as when it is desired to provide a medium fortissue ingrowth on one side and a smooth surface on the other side.These and other appropriate cardiovascular fabrics are commerciallyavailable from Bard Peripheral Vascular, Inc. of Tempe, Ariz., forexample. In another embodiment, the graft material or portions thereofmay be a natural material, such as pericardium or another membranoustissue.

In one or more embodiments, the prosthetic valve and/or one or more ofits components or portions may comprise, be coated with, be coveredwith, be constrained by, or be attached or coupled to a shape memorymaterial, a bioresorbable material, and/or a biodegradable material,such as a natural or synthetic biodegradable polymer, non-limitingexamples of which include polysaccharides such as alginate, dextran,cellulose, collagen, and chemical derivatives thereof, proteins such asalbumin, and copolymer blends thereof, alone or in combination withsynthetic polymers, polyhydroxy acids, such as polylactides,polyglycolides and copolymers thereof, poly(ethylene terephthalate),poly(hydroxybutyric acid); poly(hydroxyvaleric acid), poly[lactide-co-(E-caprolactone)]; poly[glycolide-co-(E-caprolactone)],polycarbonates, poly(pseudo amino acids); poly(amino acids);poly(hydroxyalkanoate)s, polyanhydrides; polyortho esters, and blendsand copolymers thereof. In one or more embodiments, one or more surfacesof the valve prosthesis and/or one or more of its components or portionsmay comprise, be covered with, be coated with, or be attached or coupledto one or more glues and/or adhesives, such as a bioglue or bioadhesiveused to help anchor and/or seal the valve prosthesis to native tissue.

In one or more embodiments, one or more surfaces of the prosthetic valveand/or one or more of its components or portions may comprise, becovered with, be coated with, or be attached or coupled to one or moreradioactive materials and/or biological agents, for example, ananticoagulant agent, an antithrombotic agent, a clotting agent, aplatelet agent, an anti-inflammatory agent, an antibody, an antigen, animmunoglobulin, a defense agent, an enzyme, a hormone, a growth factor,a neurotransmitter, a cytokine, a blood agent, a regulatory agent, atransport agent, a fibrous agent, a protein, a peptide, a proteoglycan,a toxin, an antibiotic agent, an antibacterial agent, an antimicrobialagent, a bacterial agent or component, hyaluronic acid, apolysaccharide, a carbohydrate, a fatty acid, a catalyst, a drug, avitamin, a DNA segment, a RNA segment, a nucleic acid, a lectin, anantiviral agent, a viral agent or component, a genetic agent, a ligandand/or a dye (which acts as a biological ligand). Biological agents maybe found in nature (naturally occurring) or may be chemicallysynthesized by a variety of methods well known in the art.

In one or more embodiments, the prosthetic valve and/or one or more ofits components or portions may comprise, be coated with, be coveredwith, or be attached or coupled to one or more biological cells ortissues, for example, tissue cells, cardiac cells, contractile cells,muscle cells, heart muscle cells, smooth muscle cells, skeletal musclecells, autologous cells, allogenic cells, xenogenic cells, stem cells,genetically engineered cells, non-engineered cells, mixtures of cells,precursor cells, immunologically neutral cells, differentiated cells,undifferentiated cells, natural tissue, synthetic tissue, animal tissue,human tissue, porcine tissue, equine tissue, porcine tissue, bovinetissue, ovine tissue, autologous tissue, allogenic tissue, xenogenictissue, autograft tissue, genetically engineered tissue, non-engineeredtissue, mixtures of tissues, cardiac tissue, pericardial tissue, cardiacvalve tissue, membranous tissue, and/or intestinal submucosa tissue. Inone or more embodiments, valve prosthesis and/or one or more of itscomponents or portions may comprise, be covered with, be coated with, orbe attached or coupled to one or more materials that promote the growthof cells and/or tissue. In one or more embodiments, the cell and/ortissue promoting materials may comprise, possess or be configured topossess physical characteristics such as size, shape, porosity, matrixstructure, fiber structure, and/or chemical characteristics such asgrowth factors, biological agents, that promote and/or aid, for example,in the adherence, proliferation and/or growth of desired cells and/ortissues in vivo following implantation or ex vivo prior to implantation.In one or more embodiments, the cell and/or tissue promoting materialsmay accelerate the healing response of the patient following theimplantation of the valve prosthesis. In one or more embodiments, thecell and/or tissue promoting materials may comprise pockets, parachutes,voids, and/or openings, for example, that may trap cells and/or tissuesand/or promote cells and/or tissues to proliferate, grow and/or heal.

In one or more embodiments, the prosthetic valve may comprise one ormore active and/or passive fixation elements or members such as anchors,barbs, prongs, clips, grommets, sutures, and/or screws. In one or moreembodiments, one or more active and/or passive fixation elements ormembers may be delivered separately from the prosthetic valve. In one ormore embodiments, one or more active and/or passive fixation elements ormembers may be delivered before, during, and/or after the prostheticvalve implant procedure. In one or more embodiments, one or more activefixation elements or members may be activated by pushing, pulling,twisting, screwing and/or turning motion or movement. In one or moreembodiments, one or more fixation elements or members may be released orengaged via an unsheathing, an unsleeving, a dissolving, and/or adegrading action. In one or more embodiments, one or more active and/orpassive fixation elements or members may be delivered using a fixationelement delivery system. In one or more embodiments, one or more activeand/or passive fixation elements or members may be coupled, connected,and/or attached to the prosthetic valve stent or frame. In one or moreembodiments, the prosthetic valve stent or frame may comprise a unitarystructure that comprises one or more active and/or passive fixationelements. In one or more embodiments, one or more active and/or passivefixation elements may be coupled, connected, and/or attached to theprosthetic valve skirt and/or graft material. In one or moreembodiments, one or more fixation elements or members may be designed toincreasingly engage one or more heart tissues and/or structures via anymovement of the prosthetic valve relative to heart tissue and/orstructures during one or more cardiac cycles. For example, a barbedfixation element that further embeds itself into tissue via movement ofthe prosthetic valve prosthesis relative to tissue in one direction andthen resists movement of the prosthetic valve relative to tissue in theopposite direction.

The prosthetic valves of the present disclosure provide a markedimprovement over previous designs. By incorporating a baffle structuretailored to induce laminar or near laminar flow into blood flow exitingthe outflow side of the valve structure, as the blood flow theninterfaces with the stent frame or other regions of the prostheticvalve, occurrences of stagnant or turbulent flow are reduced oreliminated, thereby eliminating a possible contributor to thrombusformation.

Although the present disclosure has been described with reference topreferred embodiments, workers skilled in the art will recognize thatchanges can be made in form and detail without departing from the spiritand scope of the present disclosure.

What is claimed is:
 1. A prosthetic valve having an inflow end oppositean outflow end, the prosthetic valve comprising: a stent frame defininga lumen; a valve structure disposed within the lumen and configured todefine an inflow side and an outflow side opposite the inflow side;wherein an outflow track is established within the lumen downstream ofthe outflow side and along which fluid flow from the valve structureprogresses; and a baffle structure connected to the stent framedownstream of the outflow side; wherein the baffle structure furtherincludes a plurality of baffle members each projecting into the lumen.2. The prosthetic valve of claim 1, wherein the baffle structure isconfigured and located to encourage laminar flow into blood flowimmediately downstream of the outflow side.
 3. The prosthetic valve ofclaim 1, wherein the baffle structure is configured to manipulate anatural flow profile of blood flow at the outflow side of the valvestructure.
 4. The prosthetic valve of claim 3, wherein the bafflestructure is configured to disrupt at least 10% of the natural flowprofile.
 5. The prosthetic valve of claim 1, wherein the lumen has adiameter and further wherein the baffle structure includes a firstbaffle member projecting across less than an entirety of the diameter.6. The prosthetic valve of claim 1, wherein the plurality of bafflemembers are located about a circumference of the stent frame.
 7. Theprosthetic valve of claim 6, wherein the baffle members areequidistantly spaced.
 8. The prosthetic valve of claim 6, wherein thebaffle members are longitudinally aligned.
 9. The prosthetic valve ofclaim 6, wherein at least one of the baffle members is arranged at anangle relative to a longitudinal axis of the stent frame.
 10. Theprosthetic valve of claim 6, wherein each of the baffle membersterminates in a leading edge opposite the stent frame, and furtherwherein the leading edge of at least one of the baffle members iscurved.
 11. The prosthetic valve of claim 6, wherein at least one of thebaffle members is a paddle.
 12. The prosthetic valve of claim 1, whereinthe stent frame defines the outflow end of the prosthetic valve, andfurther wherein the baffle structure is located between the outflow endof the stent frame and the outflow side of the valve structure.
 13. Theprosthetic valve of claim 1, wherein the prosthetic valve is aprosthetic heart valve.
 14. The prosthetic valve of claim 1, wherein theprosthetic valve is a prosthetic mitral valve.
 15. The prosthetic valveof claim 1, wherein at least one baffle member defines a major plane andthe stent frame defines a longitudinal axis; further wherein at leastone baffle member is arranged such that the major plane does notintersect the longitudinal axis of the stent frame.
 16. A method ofregulating fluid flow through a body vessel of a patient, the methodcomprising: implanting a prosthetic valve within the body vessel, theprosthetic valve having an inflow end opposite an outflow end andincluding: a stent frame defining a lumen, a valve structure disposedwithin the lumen and configured to define an inflow side and an outflowside opposite the inflow side, wherein an outflow track is establishedwithin the lumen downstream of the outflow side and along which fluidflow from the valve structure progresses, a baffle structure connectedto the stent frame downstream of the outflow side; wherein the bafflestructure further includes a plurality of baffle members each projectinginto the lumen, wherein fluid flow within the body vessel is naturallydirected to the inflow side; and further wherein the valve structurefunctions to alternately allow and occlude fluid flow from the inflowside to the outflow side; and even further wherein the baffle structurefunctions to encourage laminar flow into fluid flow from the outflowside.
 17. The method of claim 16, wherein fluid flow from the outflowside of the valve structure interfaces with the baffle structure priorto exiting from the outflow end.
 18. The method of claim 16, whereinfluid flow from the outflow side of the valve structure interfaces withthe baffle structure after exiting from the outflow side, and theninterfaces with the stent structure after interfacing with the bafflestructure.
 19. The method of claim 16, wherein the body vessel includesa native mitral valve annulus.